Active NPI
Russell Fuller McKinley, DDS
- General Practice Dentistry
- Boise, ID
National Provider Identifier
1457370686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D1869
- Practice address
- 2600 Rose Hill
Ste 100
Boise, ID 83705 - Phone
- (208) 345-1386
- Fax
- (208) 345-2995
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D1869 | ID | Primary |
Addresses
Primary practice location
2600 Rose Hill
Ste 100
Boise, ID 83705
Mailing address
2600 Rose Hill
Ste 100
Boise, ID 83705
Phone (208) 345-1386
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010012469 | Other | ID | BLUE SHIELD |
| 000010012469 | Other | CARING FOUNDATION BLUE SH | |
| 532545 | Other | UNITED CONCORDIA | |
| 3127302 | Other | BLUE CROSS BLUE SHIELD TN | |
| 69450 | Other | ID | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1869 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457370686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 ROSE HILL",
"address_2": "STE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "83705",
"telephone_number": "208-345-1386",
"fax_number": "208-345-2995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 ROSE HILL",
"address_2": "STE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "83705",
"telephone_number": "208-345-1386",
"fax_number": "208-345-2995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY",
"first_name": "RUSSELL",
"middle_name": "FULLER",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D1869",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010012469",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARING FOUNDATION BLUE SH",
"identifier": "000010012469",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "532545",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "3127302",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "69450",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.